NEW YORK (Reuters Health) - Lung transplantation in
children with cystic fibrosis (CF) is not likely to prolong
life and may do more harm than good, according to a look back
at essentially the entire U.S. pediatric experience with lung
transplantation for cystic fibrosis for the period 1992 through
2002.

According to a report in November 22 issue of The New
England Journal of Medicine, a total of 248 of the 514 children
with cystic fibrosis who were on the waiting list during the
10-year-period underwent lung transplantation.

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"We fully expected, at the start of the study, that we
would find a group that did well and others that did not do so
well. Unfortunately, we found that the group that most likely
did well with transplant was very small, while the group that
most likely did poorly (worse than if not transplanted) was
quite large," Liou said.

Specifically, analyses showed that only five children had a
significant estimated benefit associated with lung
transplantation. The majority of children -- 315 to be exact --
were at significant risk for harm from lung transplant, while
for 194 children, the procedure was not clearly harmful or
beneficial.

"Our paper essentially points out how difficult it is to
find the patients most likely to die soon and thus most likely
to have a survival increase by transplantation," Liou said.

"One possible reason why there doesn't seem to be much
survival benefit would be that conventional therapy for cystic
fibrosis has gotten so good that children with cystic fibrosis
are simply no longer dying," Liou suggested. "Therefore, a
lifesaving operation is not only unneeded but not possible.
Improvements in cystic fibrosis care have been steady and
remarkably effective."

"We are not trying to eliminate the procedure or take away
the last bit of hope for desperately ill children with CF,"
Liou emphasized. "We are trying very hard to look critically at
this therapy and identify how we could make it better."

Liou also noted that the data used for the study are not
sufficient to make a statement about quality of life for
children who have a lung transplant and how it compares to
quality of life without one.

"We think that some sort of study to collect the right
information to allow simultaneous assessment of the effects on
survival and quality of life in the same patient is needed,"
Liou said.